Health utilities for non-melanoma skin cancers and pre-cancerous lesions: A systematic review.

Background: Non-melanoma skin cancers (NMSCs) are common and consume many healthcare resources. A health utility is a single preference-based value for assessing health-related quality of life, which can be used in economic evaluations. There are scarce data on health utilities for NMSCs. Objectives: Using a systematic review approach, we synthesized the current data on NMSC-related health utilities. Methods: A systematic review of studies of NMSC-related health utilities was conducted in Medline, Embase, and Cochrane databases. Data were extracted based on the protocol and a quality assessment was performed for each study. Results: The protocol resulted in 16 studies, involving 121 621 participants. Mean utility values across the studies ranged from 0.56 to 1 for undifferentiated NMSC, 0.84 to 1 for actinic keratosis, 0.45 to 1 for squamous cell carcinoma, and 0.67 to 1 for basal cell carcinoma. There was considerable variability in utilities by type of cancer, stage of diagnosis, time to treatment, treatment modality, and quality of life instrument or method. Utility values were predominantly based on the EuroQol 5-dimension instrument and ranged from 0.45 to 0.96, while other measurement methods produced values ranging from 0.67 to 1. Lower utility values were observed for advanced cancers and for the time period during and immediately after treatment, after which values gradually returned to pre-treatment levels. Conclusions: Most utility values clustered around relatively high values of 0.8 to 1, suggesting small decrements in quality of life associated with most NMSCs and their precursors. Variability in utilities indicates that careful characterization is required for measures to be used in economic evaluations.

People with Type Diabetes Mellitus (T1DM) self-reported views on their own condition management reveal links to potentially improved outcomes and potential areas for service improvement.

BACKGROUND: The self-management of type 1 diabetes (T1DM) has moved forward in many areas over the last 40 years. Our study asked people with T1DM what is their experience of blood glucose (BG) monitoring day to day and how this influences decisions about insulin dosing. METHODS: An on-line self-reported questionnaire containing 44 questions prepared after consultation with clinicians and patients was circulated to people with T1DM 116 responders provided completed responses. Fixed responses were allocated specific values (e.g. not confident = 0 fairly confident = 1). Multivariate regression analysis was carried out. Only those 5 factors with p-value <0.05 were retained. RESULTS: 59% of respondents were >50 years old and 66% had diabetes for >20 years, with 63% of patients reporting HbA1c results ≤8% or 64 mmol/mol. Findings included; 75% used only 1 m; 56% had used the same meter for ≥3 years; 10% had tried flash monitors; 47% were concerned about current BG level; 85% were concerned about long-term impact of higher BG. 72% of respondents keep BG level high to avoid hypoglycaemia; 25% used ≥7 mmol/L as pre-meal BG target to calculate dose; 65% were concerned they might be over/under-dosing; 83% did not discuss accuracy when choosing meter. However 85% were confident in their meter's performance. The factors that linked to LOWER HbA1c included LESS units of basal insulin (p < 0.001), HIGHER number of daily BG tests (p = 0.008), LOWER bedtime blood glucose (p = 0.009), HIGHER patient's concern over long-term impact of high BG (BG) (p < 0.009 but LOWER patient's concern over current BG values (p = 0.009). The final statistical model could explain 41% of the observed variation in HbA1c. CONCLUSION: Many people still run their BG high to avoid hypoglycaemia. Concern about the longer-term consequences of suboptimal glycaemic control was associated with a lower HbA1c and is an area to explore in the future when considering how to help people with T1DM.

Effect of stanozolol on factors VIII and IX and serum aminotransferases in haemophilia.

The treatment of haemophilia has been dramatically improved since the introduction of factor VIII and IX concentrates, however these concentrates have brought new problems such as hepatitis and A.I.D.S. An oral agent which could raise endogenous levels of factor VIII and IX would be of great benefit. Danazol, an anabolic steroid, has recently been shown to increase levels of factors VIII and IX in haemophilia. We therefore studied the effect of stanozolol, a closely related anabolic steroid, in 15 patients with haemophilia A or Christmas disease over a 2-4 week period. There was no consistent change in factor VIIIc or factor IX, and fibrinolysis was significantly enhanced. No effect was apparent on the incidence of spontaneous bleeds. However serum aminotransferases which were abnormal in 11 of the 15 patients at the start of the study fell significantly with stanozolol therapy. This raises the interesting possibility that anabolic steroids may be beneficial in patients with chronic liver diseases.

The inheritance of abnormal sialoglycoproteins found in a Gerbich negative individual.

The Gerbich blood group antigens are probably expressed on one or more of the minor erythrocyte (beta, beta 1, or gamma) sialoglycoproteins which are lacking in some rare individuals having the Gerbich negative phenotype. A monoclonal antibody, CMRF-10, which recognises a trypsin-sensitive site on both the beta and beta 1 sialoglycoproteins, was tested for binding to erythrocytes from a Gerbich negative individual, OM. Erythrocytes from OM bound CMRF-10 in similar amounts to normal erythrocytes even though membranes from OM were shown by sodium dodecyl sulphate-polyacrylamide gel electrophoresis to lack both the beta and gamma sialoglycoproteins found in normal red blood cells. Instead, abnormal sialoglycoproteins which migrated as two bands with apparent molecular weights within the range 29,500-32,500 daltons were identified and purified using CMRF-10. Subsequent electrophoretic analysis of OM's two children failed to reveal any abnormal sialoglycoproteins. This suggests that in this instance the Gerbich negative phenotype may result from other mechanisms, possibly defective glycosylation, rather than a crossover involving the gene coding for the primary protein structure of the sialoglycoproteins.

Jk(a-b-) red blood cells resist urea lysis.

Falsely high automated platelet counts in a patient with aplastic anemia were found to be due to increased resistance of the red blood cells to urea lysis. The patient's blood group Jk(a-b-). Further investigation revealed that this phenomenon occurred with all of eight bloods of the phenotype Jk(a-b-) but not with red blood cells of other phenotypes tested. We therefore report an association of a rare blood group phenotype with unusual red blood cell behavior in vitro.

Group psychotherapy in acute treatment settings: theory and technique.

Group psychotherapy has long been a part of most inpatient and partial hospital programs, but conducting groups in these settings has become more difficult as the average patient stay has shortened. The authors integrate findings from previous research in which patients ranked the importance of several therapeutic processes in acute care groups, and they suggest a theory of group psychotherapy that incorporates realistic clinical objectives for these short-term settings. Seven therapeutic factors--self-responsibility, self-understanding, instillation of hope, group cohesiveness, catharsis, altruism, and universality--are identified as important in promoting patient change. Specific techniques to enhance these factors in short-term settings are recommended.

A group psychotherapy model for acute treatment settings.

Traditional models of group psychotherapy have become less applicable in inpatient and partial hospital programs as the lengths of stay in these programs have decreased. Shorter lengths of stay are associated with rapid changes in group membership and high levels of symptoms among group members. The clinical objectives and clinical techniques suggested by traditional group models are simply less relevant under these conditions. In this paper the authors outline a model of group psychotherapy designed to meet the needs of acutely ill patients and accommodate to the demands of the short-term acute-care setting. Drawing on previous research that has identified the therapeutic factors that operate in these groups, the authors offer specific recommendations regarding group structure, therapist role, and clinical technique.

Blood group, red cell enzyme and serum protein types in the Buka Islanders, Papua New Guinea.

Genetic marker studies on a sample of 80 speakers of the Petats and Tinputs families of languages, all pupils at a single high school, indicate a homogeneity among them which can be extrapolated to their areas of origin. Buka and its offshore islands and the northern part of Bougainville Island in the North Solomons Province of Papua New Guinea. Several markers systems, most notably first-locus phosphoglucomutase and liver acetyltransferase, reinforce the morphological evidence that these peoples are quite distinct from most other Papua New Guinea populations, with whom, however, there has been some gene exchange, probably through East New Britain. Their principal affinities are with the peoples of the Solomon Islands to the south.

Change in primary health care: new wine in old bottles?

Describes the findings from the first year of an evaluation of change at a PMS+ site in West Cumbria. The study has used qualitative methods including non-participant observation at the site; face to face interviews with 28 clinical staff; group interviews with administrative and secretarial staff; and the collection of documents. Analysis of the data against a set of "outcome indicators" shows that significant progress has been made towards implementing the model of primary care delivery described in the pilot proposal. Multidisciplinary working is developing in the clinical action groups and the establishment of a primary care emergency unit has changed general practitioner workloads. The new organisation structure is not yet working wholly as anticipated but recently initiated changes are intended to strengthen the role and authority of the management board.

A population genetic study of Goodenough Island, Papua New Guinea.

A sample of 105 coastal people and 82 mountain dwellers from Goodenough Island, off the eastern tip of Papua New Guinea have been tested for four blood group systems, haemoglobin, 17 enzyme systems and four serum proteins. Transferrins D1 and Blae were found in both populations and the frequency of almost 29% for PGDc in the mountain people is one of the highest for the region. Deficiency of G-6 PD and the presence of PGK4 were detected only in the coastal populations.

The genetic demography of the Gainj of Papua New Guinea. I. Local differentiation of blood group, red cell enzyme, and serum protein allele frequencies.

Allele frequencies are reported for 19 blood group, red cell enzyme, and serum protein loci (ABO, Rh, MN, Hb-A, LDH-A, LDH-B, SOD, PGM-1, PGM-2, 6PGD, GPT, ESD, ADA, ACP, PGK, MDH, Alb, Hp, and Tf) determined from 310 blood samples collected among the Gainj, a small population of tribal horticulturalists from highland Papua New Guniea. Fourteen of these loci display genetic variants, and ten of them are sufficiently polymorphic to permit a preliminary analysis of Gainj population structure. Patterns of variation among subdivisions of the population are analyzed using an approach analogous to a multivariate analysis of variance with unbalanced design, and weighted genetic distances are extracted from the results. The distance analysis indicates that patterns of genetic variation within this population reflect the geographical distribution of subdivisions, as well as subdivision size and movement among subdivisions. A parallel analysis of the Gainj and two other tribal groups from highland New Guinea, the Murapin Enga and the Simbai Valley Maring, suggests that the Gainj are both genetically divergent from neighboring populations and internally highly differentiated.

Productivity, quality, and patient satisfaction: comparison of part-time and full-time primary care physicians.

CONTEXT: Although few data are available, many believe that part-time primary care physicians (PCPs) are less productive and provide lower quality care than full-time PCPs. Some insurers exclude part-time PCPs from their provider networks. OBJECTIVE: To compare productivity, quality of preventive care, patient satisfaction, and risk-adjusted resource utilization of part-time and full-time PCPs. DESIGN: Retrospective cohort study. SETTING: Boston. PARTICIPANTS: PCPs affiliated with 2 academic outpatient primary care networks. MEASUREMENTS: PCP productivity, patient satisfaction, resource utilization, and compliance with screening guidelines. RESULTS: Part-time PCP productivity was greater than that of full-time PCPs (2.1 work relative value units (RVUs)/bookable clinical hour versus 1.3 work RVUs/bookable clinical hour, P< .01). A similar proportion of part-time PCPs (80%) and full-time PCPs (75%) met targets for mammography, Pap smears, and cholesterol screening (P = .67). After adjusting for clinical case mix, practice location, gender, board certification status, and years in practice, resource utilization of part-time PCPs (138 dollars [95% confidence interval (CI), 108 dollars to 167 dollars]) was similar to that of full-time PCPs (139 dollars [95% CI, 108 dollars to 170 dollars], P = .92). Patient satisfaction was similar for part-time and full-time PCPs. CONCLUSIONS: In these academic primary care practices, rates of patient satisfaction, compliance with screening guidelines, and resource utilization were similar for part-time PCPs compared to full-time PCPs. Productivity per clinical hour was markedly higher for part-time PCPs. Despite study limitations, these data suggest that academic part-time PCPs are at least as efficient as full-time PCPs and that the quality of their work is similar.